US plan paints grim picture of flu pandemic

Oct 10, 2005 (CIDRAP News)  A not-yet-released version of the Bush administration's plan for dealing with an influenza pandemic predicts that such an event could exact an enormous toll in life and wealth, according to recent newspaper reports.

The New York Times, which obtained a recent draft of the plan, said it describes a worst-case scenario in which the flu would kill more than 1.9 million Americans, put 8.5 million in hospitals, and cost more than $450 billion.

Those numbers suggest that the Department of Health and Human Services (HHS) is taking a more somber view of the risks than it did in the previous draft plan, released in August 2004. That document cited earlier estimates that pandemic flu could cause between 89,000 and 207,000 deaths in the United States.

The new draft predicts that an emerging pandemic in Asia, where widespread avian flu has killed more than 60 people and generated fear of an epidemic, would be likely to reach US shores in a few months or even weeks, the Times said in an Oct 8 report. Quarantines and travel restrictions, while recommended, probably would not postpone the disease's arrival "by more than a month or two."

The document says a pandemic could overwhelm hospitals, touch off riots at vaccination clinics, and lead to power and food shortages, the newspaper said.

However, infectious disease expert Michael T. Osterholm said the draft plan obtained by the Times is out of date. "There have been tremendous improvements in the plan over the last week to 10 days," an Oct 9 report in the Washington Post quoted Osterholm as saying. He is director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of this site.

Until recently, the plan regarded a pandemic as "more like an earthquake or hurricane," he told the Post. But a pandemic is an event that unfolds over 12 to 18 months, and the plan is now "in flux," he said.

Osterholm confirmed that the plan predicts a death toll as high as 1.9 million, with as many as half of all Americans getting sick.

Under the plan, he told the newspaper, the military probably would be used to help move critical supplies and guard vaccination centers. But the document foresees only a small role for quarantines, and many decisions on how to manage disruptions and shortages would be made by local, not national, officials.

According to the Times, the plan says the nation should have the capacity to produce 600 million doses of vaccine within 6 months, more than 10 times the current capacity. It also calls for a national stockpile of 133 million treatment courses of antiviral drugs.

The administration has said it has 4.3 million treatment courses of oseltamivir (Tamiflu) and is aiming for 20 million.

On the crucial question of who would get vaccine first in a pandemic, the plan's answer is workers who make the vaccines and flu drugs, along with medical personnel caring for flu patients, the Times story said. Following them would be the elderly and severely ill, pregnant women, transplant and AIDS patients, and parents of babies. Firefighters and government leaders would be next.

One section of the plan, the Times reported, describes a hypothetical scenario in which severe respiratory illness erupts in a village overseas in April, reaches the United States in June, and triggers small outbreaks around the nation by July. When scientists isolate the virus, as the scenario goes, they determine that the avian flu vaccine developed in advance will provide only partial protection.

Release of the draft plan has been expected for weeks. HHS Secretary Mike Leavitt, now visiting Southeast Asia to promote pandemic preparedness, said the plan would be released in a few days, according to an Associated press (AP) report published today.

But according to the Post story, HHS spokeswoman Christina Pearson said the agency is still getting comments on the plan, and releasing it now would be "totally premature."

In related news, Leavitt said during his Southeast Asian visit that the United States is pleased with Thailand's cooperation in battling avian flu, according to an Agence France-Presse report today. Leavitt said the US wants "to have that same relationship with others in the world."

Leavitt is accompanied on his tour by World Health Organization Director-General Lee Jong-Wook.